Tag Archives: childbirth

Maternal Mental Health

Back in March, I came across an article that I thought was very sensible indeed. Seeing as I am more than a bit worried about global warming (I’ve moved on from nuclear disaster, although I lost a lot of sleep over it in my early teens, worrying, as my school was nine miles away from home, that the bomb would go up when I was there) and also about equal rights, and generally interested in matters of education, it made a lot of sense. Educate girls through to the end of the secondary years and all sorts of wonderful things happen that have a direct impact on, for instance, world health and population growth, and thus the preservation of the planet.

Apparently, my auntie Pauline, a very old and somewhat mythical lady by the time I came along, I have a vague memory of white hair drawn back into a neat bun, and dark, dusty corridors with the sort of carpets that didn’t meet the walls, used to say that if you educate a girl, you educate the family; that, while the effects on the individual are profound, the ripples of your positive actions are powerful and far-reaching. And, when I think about it, an education does more than give young (and older) women the knowledge that will enable them to understand, and control, their fertility, but is the means to the confidence to ask important questions of their sexual partners too. No longer do women of my generation have to go through what my great-great grandmother did, and bear thirteen children because she was unable to refuse a Friday night after a visit to the pub.

The thing is, though, that I think that it is more than education that matters in the lives of mothers. I remember, almost as if it were yesterday, a conversation I had with my mum when I was expecting S, my firstborn. I was OK with being pregnant (although I did cry the day I could no longer fit into my jeans, because I knew that, from that moment, nothing would ever be the same again), but every time I thought about giving birth it was if I was staring into a black hole of terror.

“You’ll be alright Nancy,” she said, in that practical way of women who have been through the whole messy business and come out the other side, “it’s not THAT bad.” It was strangely reassuring. If she could do it, so could I.

That said, the experience was, for me, traumatising; and I know I am not alone. When S was tiny, I joined the local library (I’d given up paid work for a while, so I didn’t have any money) and one of the books I read was an account of early motherhood that took on the difficulties, face first. The sleeplessness, the constant responsibility, post-partum pain and the trials and tribulations of feeding the baby, no matter how you do it. It’s a treadmill, all on top of the physical shock that is giving birth. Even when it goes well (and I’ve done that bit too), and everything is fine, there is nothing about the process that is easy. There is a sense of being ripped apart – and then having to get on with nursing a baby (and possibly one or two toddlers) before the ragged edges have even begun to knit together.

Put traumatic birth, and by that I mean anything from mass intervention to emotional shock and something wrong with the baby, from jaundice to chromosomes, defects requiring surgery or brain damage, in the same event and you have a recipe for disaster in terms of maternal mental health and wellbeing. And, like an education, when a mother is well supported, so is the rest of the family.

What annoys me is that we know this. We know that the mental health of mothers of disabled children is fragile. We know that when there is a disabled child, there is often a slow slide into personal isolation, marital breakdown and poverty. We know that the lives of mothers of disabled children can be dominated by conflict and struggle, with education, with health and social care – and yet what are we doing about it? The Children and Families’ Act?

There are real and concrete actions that maternity services could put into place in order to support new mothers, and thus the wider family. Greater support from midwives and health visitors, access to a counsellor – and not just one offer, but an open door, especially where health concerns over the baby mean that mama is a long way down the list of concerns. It shouldn’t get to crisis point before someone steps in. We need to stop pussyfooting round the edges with our educational solutions and go right back to the start.

I, it seems, was lucky.

And I hate writing that because I don’t believe in luck.

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The Body Politic

If it weren’t for the pressure I feel under to be thin, I could almost believe that my body was my own.  I sit, every morning, eyeing my breakfast and telling myself I ought to eat less, be less; every morsel that passes my lips laced with an added helping of guilt.

I never used to worry about being thin.  I never even used to think about it.  All those women, publicly plastered over the pages of magazines, paraded on the telly and in films, naked in newspapers; they had nothing to do with me.  I was young, and strong(ish).  My body was a sign of my power.  It was mine, and I wasn’t reducing it for anyone.

I remember the moment when I understood that it didn’t really belong to me at all.  I was sitting in a blandly lightish-beige office, chatting to a doctor, an obstetrician.  She was older than me, but not by much, and she was dandling Sam upon her knee.  I’d been asked to go in to talk about…something, I’m not quite sure what.  I thought it was probably to do with the mechanics of giving birth, but it wasn’t.  It was about Sam.  There she sat, cuddling my baby, who sat, in turn, clutching at his toes in the way that babies do, and she looked at me straight and this is what she said.

“If I found out that I was carrying a baby with Down’s, I’d have a termination.”

And like that, I knew.

I should have known it before, really.  I should have twigged the moment someone took a machine and looked inside me (and told me to go away and get rid of HALF of the pint of water I had dutifully consumed – HALF!) to see what was going on with my baby.  I should have realised when I stuck the picture, grainy and black and white, to the classroom door.

It didn’t occur to me the first time that someone patted my pregnant bump (I didn’t have to explain back then that it was a food baby), or held shop doors open as I waddled along, or gave up their seat for me on the bus.  It should have struck me more forcibly when I sat with friends and we regaled each other with tales from the delivery room; we cried with laughter over the pop-eyed question as to whether anyone else would care to take a look, or even better, have a root around in there, but it didn’t.  Maybe it was the slight hysteria brought on by a lack of sleep.

Whatever it was, I didn’t realise that my body was no longer a private thing, and that what I did with it was a matter for public debate until that moment.  If I was a responsible person, I would get myself checked, I would allow not only scans, but needles, to enter; a physical consequence of a not-so-hidden judgement.

But this thing, this thing about Down’s syndrome I take particularly hard, because it’s not about clothes or hair or breast or bottle or even whether you are having a baby at all.  It isn’t about buggy choice and what-that-says-about-you, or where you let your baby sleep or who sets the routine – or not.  It’s not even something that affects only older mothers, the geriatric ones, because, you know, risk.

It’s about the way that women’s bodies are continuously policed, and that what is dressed up as choice is really about control.

 

There’s a TV programme coming up next week, and I have written this post as a way of working out my thoughts before it airs.  I appreciate it is a difficult subject – and one that affects us all.

http://www.bbc.co.uk/programmes/b07ycbj5

Counting the Cost

One of the first things I ever wrote for publication was a piece on miscarriage.  It was a long time ago, L was still a tiny baby, and in order to write it, I talked to a number of women, all of whom had had one, me included.  It’s strange, but it is one of those things that it shrouded in mystery, a silent mourning, until the moment you step over the threshold of birth.

Maybe it has something to do with work.  At work, no one has the time (nor the inclination) to go into the details of your reproductive woes.  It isn’t the place (you are supposed to be working, after all), and, well, it just isn’t obvious.  Everyone can tell when you are having a baby (at least when you pass the Too Many Cakes Stage), once that bump is on show, your status is one of public scrutiny and comment, but before, that is the time of shadows, of half-admitted hopes and dreams.

There is so much about the female condition that is both shrouded in mystery and guarded by thresholds.  It makes me wonder whether there is ever such a thing as an essential self, the bit that never changes, when you are female.  I look back at the child, the teenager, the young woman, mother, and I wonder if I actually, when it comes down to it, have anything much in common with them.  The years, and the crossing of thresholds, have changed me in a way that the male condition does not.

In a way, thanks to Sam’s very public disability, I had a passport into the shared pain of loss at an early stage.  Nobody looked at me, when we ventured out into the public/private world of the coffee morning and the toddler group, the informal and cathartic glue that holds us together in the early years of motherhood, and thought, ‘well, what would she know?’  That’s the problem with miscarriage, you see, or difficulties in conceiving; their invisibility.  If you didn’t know, you’d never know.

But the stories of loss that I have been privy to, of repeated mourning, of joy snatched for only a short time, together with my own, and others’ experience of difference, of disability, and my doctor’s muttered comfort that it was a wonder that the human race managed to reproduce at all, given the statistics, have conspired to teach me a salutary lesson about life, and humanity.

We think we have control.  We think we have choices.  We think we are beyond our animal bones.  And I suppose, to a certain extent, we are.  We may be able to select our embryos, choose the pettiest, or the most intelligent, test the genes (and not just for Trisomy 21), screen for all manner of things we just don’t fancy, be it a lack of happiness or health.  We might like to persuade ourselves that our ideas are just that; ideas devoid of morals, or ethics.  But those choices, those hard, physical choices touted as ease, they come at a cost; the price of which is loss and it is paid in tears.

Foundations

I wrote this post for Mencap, in response to their #hearmyvoice campaign. You can find it here: https://www.mencap.org.uk/blog/foundations

I remember when Sam was a tiny baby it seemed to be constantly raining.  For days, I did nothing but gaze longingly at the outside, in between feeds and nappy changes, wishing the torrents of water that streamed down the patio doors would hurry up and go away.  I wanted the sea of mud surrounding me to dry up, in part so that I could shake off the cabin fever, but also so that I could play with my lovely new travel system (great colours and suspension) and show my lovely new baby off to the world.  For a little while, it felt like a Keep Nancy In conspiracy.

Everyone who came to visit told me I was mad to want to go out into the bleak February chill.  And, once I was home, I had a LOT of visitors.  Almost the entire family, from long-lost aunts to my parents and sister, came to coo before the first two weeks were out, but, after the restrained hullaballo of the maternity ward, it was quiet.

For a while it had seemed as if I would never get home.  There were blood tests for me, blood tests for him, debates over feeding, debates over whether or not he had Down’s at all.  It took three days for the test results to come in.  We had been told, the evening of the day he was born, that it was likely that he had a chromosomal abnormality, Trisomy 21 being the chief suspect, but up until the moment when a gaggle of medics with long faces headed up the ward to my private room, I had refused to quite believe it.

I mean, I decided that I didn’t care, that I still loved him, that I was still proud of this baby I had managed to produce, but still.  Every time I went near a bath the tears leaked out, and I wrestled with my deep desire not to have to take on the added responsibility of bringing up a child with additional needs.  I can still vividly recall that moment when they confirmed what everybody really knew.  There was a collection of them, dressed in the NHS uniform of beige trousers and lavender shirts and one of them had an accent that reminded me of the character in the Fast Show, the painter, who didn’t like the colour black.  ‘It could be worse…’ kept flitting through my brain; the ridiculousness of the situation filling me up with an inappropriate desire to laugh.

It’s never a nice thing, or an easy thing to be told that there is something wrong with the baby you have waited so long for.  There is no kind way, no easy way of breaking difficult news.  But despite the heartache, I seemed to be surrounded by people who were looking out for me and Sam.  There was the midwife who took him onto her knee to help her with reception so that I could wash my hair.  There was the midwife who helped me to get him started on the journey to breastfeeding, who chased away the one who stuck a bottle in his mouth, made me eat some breakfast when I had lost my appetite.

And when I got home there were all the visitors.  Our new GP came round (we had only moved house a month before).  The community paediatrician came round (she had to endure a lecture on woodwork from my father in law).  The community midwife came round – for longer than she needed to, and brought colleagues with her, to introduce them to me and my baby.  And the health visitor.  Health visitors come in for a lot of stick, but mine, she who bustled in and out of my house with her scales and measuring whatnots, she who refused to let me come out into the rain and cold and go down to the clinic for I can’t remember how long but it was ages, she sat with me, she drank cups of tea with me, we talked. I knew, somehow, that she came because I was a high risk mother.  A traumatic birth, fear for my baby, a struggle to feed; these factors often add up to a bad case of post natal depression, but she never let me feel like a statistic.

These people, this amazing team, they knew that I was working hard to assimilate my position, to figure out what I was supposed to be doing; they surrounded me, protected me.  They joined with the women I had met through NCT antenatal classes and they heard the inner me, the one who knew that there was no such thing as normal, the one who didn’t care what anyone else thought and yet at the same time was worried about her ability to navigate the possibly stormy waters ahead.

They never pitied me.  They never made a judgemental statement about Sam (other than to inform me that his hair was not, in fact, blond, like his father’s, but sandy red, like his uncle’s, or poke him when he refused to wake up for his 6 week check).  They confirmed my desire to be pleased with him, to be glad that he was here, to celebrate the fact that we both made it out of the delivery suite in one piece.

They let me find my feet. They showed me there was solid ground.

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Spot the baby.

 

Cascade of Intervention

I reckon that I had the longest written birth plan in History.  It started (not the birth plan itself, but the ideas contained within) when I was expecting Sam, my firstborn.  After my long stay in hospital as a child, and the following years of blood tests, x-rays, scans and general check-ups, I had successfully avoided such places (if you don’t count my wisdom teeth) for some time, and now here I was, with doctors and midwives and consultants fussing fussily.

I, like many of my ilk, joined the National Childbirth Trust (NCT) first pregnancy round  partly because my friend Heather told me to) and it was there that I learned that, if I wasn’t careful, something called a ‘cascade of intervention’ could well happen to me.  Basically it means that once you intervene in the birth process, an epidural for instance, then it becomes more likely that something else will follow.  A simple example would be that if you can’t feel when/how hard to push you struggle to bring your baby to birth, so forceps or a ventouse are used, which then necessitates an episiotomy, which, in turn, needs stitches, these can get infected, can be stitched wrongly – you get the picture. The thought of this happening to me was very frightening, sending shivers not only down my spine but right out of the end of my toes.

It wasn’t just the NCT influence, though.  As a young undergraduate, I’d done a dissertation on women’s lives, loves and romance in the 16th and 17th centuries, and part of that was finding out about pregnancy and childbirth at that time.  I may have chortled at the idea of a wandering womb in a shocked-but-angry kind of way, but I could see a pattern emerging.  As midwifery left the realms of women and entered an age dominated by Men of Science, more and more mothers were messed with.  Forceps.  Positions that allowed easy access and observation, but did nothing to make the giving of life easier.  Lives lost where letting Nature take its course may well have saved them.  It may not quite have been mediaeval, but it coalesced into one desire.

What I wanted was to be left alone and do it as naturally as I could, and, being me, I wrote it all down, and added a paragraph (or two) to explain why (I left out the bit about the history of midwifery and classical allusions to Galen and the wandering womb theory, I thought that might be pretentious).  By the time I was in the delivery suite with Number Three my plan had grown to considerable proportions, including such gems as ‘please insist my husband eats something, he is diabetic and likely to keel over if this goes on too long, and he won’t say as he won’t want to be any trouble’ (this turned out to be quite a good part of the plan) and ‘if you insist on putting in a canula, please can you do it at the last possible moment and take it out as soon as you can because I really, really hate them’.  It took the midwives at least ten minutes to read, and, bless them all, they stuck as closely as possible to my wishes without me having to resort to too many tears and too much snot.

While I was busy worrying about the ‘kindest cut’ (there’s a misnomer if ever there was one), schools were buying into the concept  of intervention in an entirely different way.  Instead of it being whether a woman in labour was getting on as she ought, it became about a child.  If a child wasn’t performing, travelling along the Straight Line of Progress, then an Intervention was called for.  It took me a while, bearing in mind my aversion to messing, to get my head round the concept.  In schools, it has come to mean doing something different to the rest of the class, most likely with a Teaching Assistant, although not always, stuffed in at funny times of the day (assembly time is popular, or worse, the last ten minutes of lunch time play), or in funny places – out in the corridor, a table in the cloakroom, anywhere where you can get a bit of quiet, usually cold, and, if you have the misfortune to find yourself next to the toilets or the plimsolls, smelly.

Now that Intervention is my stock in trade, I find myself wondering about it.  I find myself wondering, knowing what I now know, just how much time my children, my Sam in particular, spent or spend in intervention groups.  OK, I know for sure some of what Sam experienced in primary school. I know that he spent his 8th birthday in the corridor – but that wasn’t so that he could be ‘intervened’, that was more a consequence of overexcitement and more fool him.  No, I find myself wondering about his  and their school experience in general.

During Sam’s primary years I often wondered just how much time he spent with his class teacher, how well they actually knew him, and I laid the deficiencies in this relationship at the feet of the TA.  It’s hard to get to know someone when there is always another person there, getting in the way.  It was one of the reasons we plumped for a special school for his secondary education  There would be no dedicated one-on-one support.  But, as I sit here contemplating The State of Education Today (or something like that), I can see that it’s a bit more complicated than that.

I can begin to see that this issue of intervention strikes at the very heart of an inclusive education.  Yes, of course if children aren’t ‘getting it’ then we need to do something about it, but at what cost?  Should they spend the majority of their days out in the corridor, or on the floor, or in cramped corners where the rest of the school passes by, being taught by a succession of people who aren’t as qualified as the teacher?   And when do these interventions take place?  Don’t these children deserve just as much Art or Music or Drama or Games or Athletics or play time as everyone else?  Don’t they deserve the chance to shine at every moment they possibly can?  Don’t they deserve the chance to be with the group, to share in the same educational experience, even if it means getting told off for doing each other’s hair during story time or staring out of the window and learning to deal with boredom?  Don’t they deserve to get to know their teacher properly, and their teacher them?

I make no apology for my support for ‘one teacher, one class’.  Yes, I could bang on about subject knowledge and all that jazz, but, and I see this every day when I go to work, I see it every day when I am at home; children do well when they know their teacher, they trust their teacher, and they are with their teacher enough for their teacher to make a difference.  Sometimes it’s the simple things that matter.